CMS Formulary

Displaying 86331-86340 of 1611142 results.
ID: 86331
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1427300
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86332
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 748800
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86333
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1599949
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 86334
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 848180
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86335
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 141850
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 86336
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197573
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 86337
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123072
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 17
Qty Limit Days: 30
ID: 86338
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 314076
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86339
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 314077
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86340
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 205326
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0